Organization
SERENITY GROVE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATYANA PROSOLUPOVA DDS (CEO)
(561) 318-0805
Entity
Organization
Contact information
Practice address
13475 SOUTHERN BLVD, SUITE 201, LOXAHATCHEE, FL 33470
(561) 318-0805
Mailing address
1331 DUVAL ST, JUPITER, FL 33458-8761
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/07/2024
Last updated
06/11/2024
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